Surgical retractor clamp connectable to an arm of the retractor

ABSTRACT

A surgical retractor having laterally extending rack with a first arm connected to the rack spaced from the second arm. A retractor clamp has a slot which engages one of the arms. Extending from the clamp is a leg with a mount which receives a connector head of a retractor blade. One or more retractor clamps may be advantageously positioned on either of the arms at a desired location. In the preferred embodiment, the mount is rotatable relative to a member housing the slot such that a retractor blade connected to the mount may be pivoted into and out of an incision. Furthermore the housing member is configured so that a hand held gripper may be connected to the connector head of a retractor blade as it extends through the mount.

CLAIM OF PRIORITY

This application claims the benefit of U.S. Provisional PatentApplication No. 60/394,342 filed Jul. 3, 2002.

BACKGROUND OF THE INVENTION

The method and devices disclosed are related to procedures and productsutilized in minimally invasive joint surgery, and more particularly toretractors and associated components which are utilized in minimallyinvasive hip surgery.

BRIEF DESCRIPTION OF RELATED ART

Traditionally, hip surgery is an invasive procedure. Surgeons usuallymake large incisions and dislocate the femur at the hip. The femur isthen placed across the patient's stomach while the surgeon accesses thehip area.

In order to shorten the recovery times, minimally invasive surgery hasbeen proposed so that recovery times can be shortened which reduces thetotal costs of the procedure. In order to perform minimally invasivesurgery on joints, such as the hip, new procedures and devices arenecessary.

SUMMARY OF THE INVENTION

A need exists for a retractor support apparatus and associatedcomponents as well as a method for their use in minimally invasive jointsurgery, including hip surgery.

A need also exists for the use of a retractor assembly and associatedcomponents for use in minimally invasive joint surgery.

Another need exists for an improved retractor.

Another need exists for an improved retractor clamp.

Yet another need exists for an improved retractor frame.

Accordingly a retractor assembly includes a retractor frame having twoarms extending from a rack. The two arms may be curved, straight, orangled. The arms may also be hinged. At least one, and possibly both ofthe arms are locatable relative to the rack. Instead of being straightas has been traditionally done, the rack may be curved such as to definean arc of a circle, or having a changing radius such as a segment of afrench curve.

Retractor clamps are utilized with the frame and may be connected toeither the arms or the rack itself. Some retractor clamps are adapted tofit slide into position and need not necessarily have any otherconnecting mechanism to secure the clamp to the arm or rack. Otherclamps have a retaining clip which may be spring biased to hold theclamp in a desired location on the arm or rack. Some clamps maintain amount in a fixed position. Other clamps have mounts which are pivotablerelative to their connection on the arm or rack. The rack or otherportion of the system may then be connected to a bed rail or verticalpost connected to the operating table or other fixture to fixedly securethe position of the retractor system components. The pivoting featureallows the mount to lift or push retractor blades into or out of anincision. The retractor clamps may be connected to a retractor handleand then to a blade. When the tissue is retracted to a desired position,the clamp is then secured to an arm or rack. The handle may then bedisconnected from the blade.

Additionally, an extension arm is illustrated connected to an arm. Theextension arm allows for substantially three hundred and sixty degreesof capability of positioning retractor clamps about an incision.

BRIEF DESCRIPTION OF THE DRAWINGS

The particular features and advantages of the invention as well as otherobjects will become apparent from the following description taken inconnection with the accompanying drawings in which:

FIG. 1 is a top plan view of a retractor frame of a presently preferredembodiment of the present invention;

FIG. 2. is a top plan view of a first alternatively preferred embodimentof the retractor frame of the present invention;

FIG. 3 a is a top plan view of a second alternatively preferredembodiment of the retractor frame of the present invention with tworetractor clamps connected thereto;

FIG. 3 b is a back side plan view of the rack used in the retractorframe of FIG. 3 a;

FIG. 4 a is a top plan view of a third alternatively preferredembodiment of the retractor frame of the present invention with anextension arm connected thereto;

FIG. 4 a is a side perspective view of the extension arm shown in FIG. 4a;

FIG. 5 is top plan view of a fourth alternatively preferred embodimentof the retractor frame of the present invention;

FIG. 6 is a side plan view of an arm of the fourth alternativelypreferred embodiment in an unlocked position;

FIG. 7 is a side plan view of a preferred retractor clamp of the presentinvention;

FIG. 8 is a side plan view of the retractor clamp of FIG. 7 with themount pivoted downwardly;

FIG. 9 is a side plan view of the retractor clamp of FIG. 7 with themount pivoted upwardly;

FIG. 10 is a top plan view of the retractor clamp of FIG. 7.

FIG. 11 is a side plan view of a first alternatively preferred retractorclamp of the present invention;

FIG. 12 is a side plan view of a second alternatively preferredretractor clamp of the present invention;

FIG. 13 is a top plan view of the retractor clamp of FIG. 12;

FIG. 14 is a side plan view of a retractor blade for use in the presentinvention;

FIG. 15 is a top plan view of the retractor blade end shown in FIG. 14.

FIG. 16 is top plan view of an alternatively preferred retractor bladeend.

FIG. 17 is a side plan view of the retractor blade end of FIG. 16;

FIG. 18 is a side plan view of a handle for use with the retractorblades of FIGS. 15-17. and

FIG. 19 is a perspective view of a surgical retractor system in use.

DETAILED DESCRIPTION OF THE DRAWINGS

Accordingly, FIGS. 1-17 show a plurality of embodiments of the devicesused with minimally invasive joint surgery. FIG. 1 shows a retractorframe 10 having a curved rack 12 or cross member. Racks of traditionalframes are not believed to have been curved structures, however thecurved rack 12 has been found helpful in applications such as jointsurgery since the distal portion 14 of the rack 12 is further from thefirst arm 18 than the proximal portion 16. In a properly designed frame10, the distal portion 14 will be out of the surgeon's way so that he orshe can access the incision between the arms 18,20.

Another feature believed to be novel is the provision of two adjustmenthousings 22,24 which are slidably mounted relative to the rack 12 witheach housing 22,24 respectively connected to the arms 18,20. Thisfeature is believed to be helpful so that the rack 12 which is notintermediate the housings 22,24 may be positioned so that is oppositethe surgeon, or otherwise located out of the way.

In FIG. 2, frame 30 is illustrated with rack 32 having a first andsecond arcs 34,36 which would have two different radii. In otherembodiments, the radii could be continuously changing such as providedby a french curve and/or include more distinct radii sections. This mayassist in providing a desired angular relationship between the arms38,40 for some surgical procedures at a desired spacing.

As can be seen by examining FIGS. 1 and 2, the arms 18,20 and 38,40 arenot parallel. While the arms 18,20 and 38,40 could be parallel in someembodiments, such as shown in FIG. 4, the non-parallel nature of thesearms is believed to be new to the art when straight arms are utilized.Additionally, as shown in FIG. 2, the angular relationship between thearms 38,40 can be varied based on where on the rack 32 the arms 38,40are positioned, especially if each arm 38,40 has a housing 42 connectedthereto to allow movement of the both arms 38,40 relative to the rack32. As can be seen in FIG. 1, the angle between first and second axes26,28 is about 15 degrees. Depending on the spacing between the housingfor a fixed radius arc segment of rack 12, the angle will vary with thespacing.

In FIG. 2, since the rack has multiple radii arc segments, the anglebetween first and second axes 44,46 is not solely dependent upon spacingbetween the arms 38,40. While the three axes 44,46,48 are substantiallyequally spaced from one another where they intersect the rack 32, theangle between the first and second axes 44,46 while the angle betweenthe second and third axes 46,48 is about forty five degrees. In otherembodiments, the radii of arc segments may be different which of coursewould affect the angular relationship of the arms 38,40 as the spacingbetween the arms is increased or decreased.

Of course, housings may be designed or provided that allow for the arms38,40 to be maintained parallel to the rack 32 through the changes inradii or for a specific radii by providing a connection of the arms atthe housing allowing rotational movement of the arm relative to thehousing or otherwise.

FIG. 3 a shows an alternatively preferred embodiment of the preferredinvention which shows some of the versatility of the retractor systemdescribed herein. Retractor 50 has a fixed arm 52 and a moveable arm 54.Unlike the hinged and straight arms shown in FIGS. 1 and 2, the arms52,54 are curved along their length. This structure is believed toassist for certain shaped incisions. The rate of curvature may varyalong the length, however the embodiment shown shows a relativelyconstant rate of curvature. The rack 56 may be substantially linear asillustrated, or could be curved as shown in FIGS. 1, 2 and 3 b. The arms52,54 as well as the rack 56 may be provided with retractor clamps58,60. Although the clamps are shown on the first arm 52, they may alsobe placed on the second arm 54 or the rack 56. The arms 52,54 may eitherhave a smooth back 62, or a scalloped back 64 depending upon the needsof the user and the particular components to be utilized with theretractor frame 50. Of course, some racks 56 can be dome shaped orcurved as shown in FIG. 3 b as well as curved as shown in FIGS. 1 and 2so that they are curved in more than two dimensions. The “doming” of therack 56 has been found helpful in getting the ends 57,59 out of asurgeon's way in some procedures.

FIGS. 4 a and 4 b has been provided to illustrate a particular accessoryfor use with retractor frames, such as with a traditional frame 70 orany of the improved frames shown in FIGS. 1-3 or others. The extensionarm 72 is believed to be a new development in the field of componentsutilized with retractor frames 70. The extension arm 72 may provide asurgeon the ability to provide substantially 360 degree coverage aboutan incision for locations to place a retractor clamp, and thus direct aretractor into an incision. This flexibility provides the surgeon withnumerous options to provide a retracted incision while minimizing anyimpediments to his vision or ability to work within the incision.

Depending on the needs of the surgeon, the extension arm 72 may besubstantially planar with the arms or it may elevate a support surface74 above the arm, illustrated as first arm 76 it is connected so thatthe support surface 74 may pass over, or under, the second arm, such assecond arm 78. Of course the extension arm 72 may be connected to thesecond arm 78 instead of the first arm 76 as illustrated. Additionally,the extension arm 72 may be equipped with a housing 80 which may eithersecure the extension arm 72 to an arm 76,78 or it may be somewhatsimilarly constructed as the housing 82 on either the first or secondarms 76,78 to allow the surgeon or assistant to retract tissue away fromthe rack 84. Additionally, the extension 74 is illustrated as having acurved and/or domed support surface 74, however it could be straight,angled or otherwise constructed such as in a manner illustrated for theracks and arms shown herein. The use of the extension arm 74 is believedto be a huge improvement over the technique shown in U.S. Pat. No.5,795,291, incorporated by reference, which requires using two retractorframes. Furthermore, the system utilized may be secured to a fixedsupport such as a vertical post 300, a rail of an operating table orother appropriate location as shown in FIG. 19.

FIGS. 5 and 6 show other features which may be incorporated intoretractor frame construction for minimally invasive joint surgery. Frame90 is illustrated having a rack 92 with arms 94,96 connected thereto.Housings 98,100 allow either of the arms 94,96 to be moved relative tothe rack 92. The arms 94,96 have intermediate segments 102,104 which areangled relative to first and second end segments 106,108 and 110,112,respectively. The first and second end segments 106,110 and 108,112 areparallel to one another, respectively.

From FIG. 6, the geometry of the arms 94,96 can be seen as beingsubstantially rectangular except where the first segment 110 connectswith housing 100. Although other geometrical arrangements can beutilized, in the embodiment shown in FIGS. 5 and 6, the first segment110 is substantially round at base 114. The base 114 has serratedsurface 116 which cooperates with serrated surface 118 on housing 100.Locking lever 120 locks and unlocks the first segment 110 relative tothe housing 100.

The first segment 110 is illustrated as being rotatable relative to thehousing 100 so that retractors may be positioned down into a wound orelevated relative to the wound when the first segment is in an unlockedconfiguration as shown in FIG. 6. This feature is also believed to beuseful with racks which are dome shaped as shown in FIG. 3 b to providea desired angle of the arms relative to the rack (for instance, theplanes the arms are in may be made to be parallel to one another eventhough the rack is not linear in some embodiments). By locking the firstsegment 110, the serrated surfaces 116,118 are brought into contact withone another to fix the rotational position of the arm 110 relative tothe housing 110. The lever 120 is operably connected to a cam (obscuredfrom view) within the first segment 110 which cooperates with post 122to move the first segment 110 relative to the housing 110. Of course,there are other ways known in the art wherein the first segment 110, ora portion of the first segment 110 may be rotatably positioned relativeto axis 124 and then secured at a desired position.

The first arm 94 is illustrated as having a similar angular adjustmentfeature as the second arm 96 which has been described in detail above.While this embodiment has hinged arms defined by segments 106,102,108and 110,104,112, the arms of FIGS. 1-4 could also be provided with thiscapability.

The interior workings of the housing 100 are also illustrated in FIG. 6.While other devices are known in the art, the housing 100 has a driver126 actuated by a handle 128. The driver 126 illustrated is a wheel withspokes 130 adapted to fit within slots 132 shown in FIG. 5. Releaselever 134 may act allow the driver 126 to act as a ratchet to move inonly one direction when in the normally biased position illustrated, orit may be depressed to disengage the driver 126 from the slots 132 toallow the arm 96 to be positioned at the will of the user of the rack92.

Referring back to FIG. 3, two clamps 58,60, are illustrated. Details ofthese clamps and others are shown in FIGS. 7-13. FIG. 7 shows a sideplan view of a clamp 140 which has a release button 142 for removing theclamp 140 once installed as shown in FIG. 3. The button acts on latch144 about pivot 146. The latch 144 is normally biased by spring 148 intoengagement with a back side 62 of an arm 52. While clamps have only beenshown in FIG. 3, the same clamps could be utilized with any of theembodiments illustrated on any of the arms or racks.

The clamp 140 has a slot 150 which receives an arm or a rack therein.The latch 144 retains the inserted frame part. The slot 150 isillustrated as defined between upper and lower surfaces 152,154. Theupper and lower surfaces 152,154 are illustrated as parallel to oneanother. The clamp has a mount 156 which connects to the member 158containing the slot 150. The mount 156 of this embodiment is moveablerelative to the member 158. This feature is not provided in the clampsshown in FIGS. 11-13.

In the clamp 140 of FIGS. 7-10, the mount 156 is connected to or morepreferably apart of leg 160. Leg 160 is operably coupled to the member158 by pivot 162. FIG. 7 shows the leg 160 substantially parallel to theslot 150. In order to change the angle of the leg 160 relative to theslot 150, operator 164 is utilized. By twisting on operator 164, threadsat distal end 166 pass through nut 168 which is then moved along theaxis of rotation of the operator 164. As the nut 168 moves, it actsagainst projections 170,172 to either pivot the leg downwardly as shownin FIG. 8, or upwardly as shown in FIG. 9. Of course, there are cutoutportions in the projections 170,172 and leg 160 which receive the distalend 166 of the operator 164 to allow for this positioning.

Should a user desire to rapidly change the angle of the mount 156relative to the slot 150, a quick release button 174 can be pushed whichdisengages threaded gear 176 to release the operator 164. Releasing thebutton 174 re-engages the gear 176 with the operator 164 to allow forcontinued adjustment with the operator 164.

FIG. 10 shows a top plan view of the clamp 140. Groove 178 providesaccess to the mount from a hand held gripper which is illustrated inFIG. 18. When using a retractor blade equipped with a head as shown inFIG. 14, the head may extend up into the mount 156 where it is held bythe hand held gripper and then the retractor is pulled or pushed into adesired location where the clamp may then be connected to an arm or rackand the hand held gripper may then release the clamp.

FIG. 11 shows an alternatively preferred embodiment of a clamp 180 whichlacks the pivotal capability of the mount 182 and leg 184 relative tothe slot 186. Apart from this difference, the clamps 140 and 180 arevery similar. The top view of the clamp 180 will be very similar to thatshown in FIG. 10 without the operator 164 extending as shown.

FIG. 12 shows another clamp 190 which slides onto an end of an arm orrack of a frame. The top view of the retractor clamp 190 of FIG. 12 isshown in FIG. 13. This clamp may either remain moveable along the arm orrack or may be outfitted with a connector such as shown on the extensionarm in FIG. 4 a or otherwise to secure the clamp 190 at a desiredlocation relative to an arm or rack.

FIG. 14 shows a retractor blade 200 which has a head 202 and a contactsurface 204. Although the contact surface 204 is illustrated as a“Hohmann” contact surface which is shown in detail in FIG. 15, FIGS.16-17 show a “Hayes” contact surface. Of course other retractor bladecontact surfaces which resemble paddles or other structures may alsoprovide a contact surface for various uses. The head 202 may take on anumber of shapes and is adapted to work with the selected mount of theclamp which will be utilized to retain the retractor blade.

FIG. 18 shows a hand held gripper 210. The gripper 210 has a handle 212which twists relative to a shoe 214. As the handle 212 is twisted, apost 218 extends into a bore in the shoe 214 and onto a top of a head202 of an inserted retractor blade 200 to secure the blade relative tothe gripper 210. The head 202 has previously been inserted into slot 216in the gripper 210. In order to release the head 202, the handle 212 istwisted in an opposite direction and the head 202 is released by thepost 218. The head 202 may then be slid out of slot 216.

Numerous alternations of the structure herein disclosed will suggestthemselves to those skilled in the art. However, it is to be understoodthat the present disclosure relates to the preferred embodiment of theinvention which is for purposes of illustration only and not to beconstrued as a limitation of the invention. All such modifications whichdo not depart from the spirit of the invention are intended to beincluded within the scope of the appended claims.

Having thus set forth the nature of the invention, what is claimedherein is:

1. A surgical retractor having a clamp operably connected to at leastone arm of the surgical retractor, the clamp comprising: a member havinga slot defined by an upper surface and a lower surface, the slot beingsubstantially parallel to a mount for receiving a portion of the arm,the member having a latch for selectively retaining the clamp at aselected position; a release button adapted to disengage the latch torelease the arm from the slot; a leg pivotally connected to the memberand extending cantilevered away from the slot at a proximate end of themember, the leg having a retractor blade connector head mount forreceiving a connector head of a retractor blade, the leg having a firstprojection and a second projection; and, an operator for adjusting theangular position of the leg, the operator having a threaded shaft, thethreaded shaft having a nut thereon, the nut located between the firstand second projection, the nut moveable along an axis of the shaft uponrotation of the shaft, the axial movement of the nut against at leastone projection rotates the leg about a pivot.
 2. The surgical retractorof claim 1, further comprising a quick release button operably connectedto the operator, the quick release button adapted to rapidly change theangle of the mount relative to the slot by disengaging the operator fromthe threaded shaft.